Provider Demographics
NPI:1104159441
Name:GOLDSTEIN, TAMARA (LMFT)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19401 S VERMONT AVE STE A200
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-4418
Mailing Address - Country:US
Mailing Address - Phone:310-323-6887
Mailing Address - Fax:310-323-1570
Practice Address - Street 1:815 S LE DOUX RD UNIT 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1869
Practice Address - Country:US
Practice Address - Phone:310-947-4978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT103992106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist